Experience with Dr Dan Lin - UW Fred Hutch Cancer Center in Seattle

I can’t tell you about Dr. Lin

Here are a couple of really good Genito Urinary Oncologists who can help you make a decision on who to have treat you.

Hutch in Washington state
Both GU Oncologists
Dr. Michael Schweitzer
Dr. Lawrence Fong

At Gleason 9 forget focal therapy. Even with a clean PSMA PET there is a good chance undetected micro-metastasis will require future salvage RT. RT can cover both prostate and surrounding areas but may not be as through within the prostate. Nothing like removal with clean margins to be sure you have it all. I had a high probability of requiring salvage RT and that was a big factor in going with RT. Everyone must choose what is best for them.
>> And yes, if you go with RT you want SpaceOAR or another rectal spacer. Also want to use Orgovyx for ADT rather than Lupron. If ARSI is also used you want a second gen lutamide (Nubeqa, Erleada, Xtandi) rather than Abbie.

@jeffmarc Ty Jeff for your guidance.

Cheers
Sergio

@jim18 Many thx for your insights. I plan to research this further as I prep for initial visit w Urologist.

Cheers
Sergio

Hi gonzaler84,
I was diagnosed with Gleason 9, treated and continue to be monitored at UW/Fred Hutch. I opted for RT rather than surgery, but I have several friends who had RALP done by Dr. Lin who have had nothing but positive things to say about the care they received from diagnosis through surgery. Each one had a very favorable outcome.

I suspect that you have already reviewed the bios of each of the physicians at Fred Hutch who treat PCa, if not, here is a link to the directory:
https://www.fredhutch.org/en/people/provider-directory.html
When I was first diagnosed, I was given appointments with gentiouary specialists in surgery, medical oncology and radiology. Each shared their perspectives on my diagnosis and treatment options as well as answering all of my questions. That said, continue to do your own due diligence. Be a strong advocate for yourself. What is known about PCa and best treatments is constantly evolving. When reading about treatments and outcomes, make certain that it pertains to men with Gleason 9 (high risk or very high risk PCa) as many of the trials and studies exclude these groups and posts on MCC may not be relevant for a man with high or very high risk disease. Check to see how old the data is that is being analyzed. Older data comes from trials or studies that were based on treatments and outcomes which are now outdated. You can also search for threads on sepecific topics on MCC, something I continue to find very helpful.

You are in great hands at The Hutch.

Bill

Based on the clarity of your comments, you already know that a Gleason 9 is considered very high risk. (May also be aggressive, the PSMA PET scan will determine this.)

> Just out of curiosity, is your Gleason 9 a 4+5 or a 5+4?

NCCN guidelines recommend two options. (See attached NCCN guidelines chart.)

> For very high risk disease, with external radiation NCCN guidelines recommends both ADT + ARPI. (Doublet therapy is not uncommon for Gleason 9 & 10.)

> Did your MRI report or biopsy report mention anything about: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma?

As for your treatment options —>
One of the understandings I had with my doctors was that (at 65y) quality-of-life and successful treatment were of equal priority for me. That set the basis for us working together and ultimately agreeing on an appropriate treatment plan.

> You’ll have to establish your own priorities in making this decision.

With success rates comparing surgery with external radiation for localized prostate cancer being statistically equivalent, it all comes down to side-effects you’re willing to deal with and quality-of-life you want afterwards (or as a paper I read put it, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).

> Take the time to figure out for yourself your priorities and what’s best for you.

If you choose external radiation, using a rectal spacer is a must, with SpaceOAR, Barrigel, and BioProtect being the options.

> Barrigel preferred to SpaceOAR because it is sculptable.
> SpaceOAR Vue preferred to the standard SpaceOAR Hydrogel because it contains approximately 1% iodine bound to the hydrogel to be more visible under CT scan.
> BioProtect is the latest of the rectal spacers (recently approved for use in 2023).

(I had 28 sessions of proton radiation (+ SpaceOAR Vue) and 6 months (two 3-month injections) of hormone therapy, for my localized, PSA of 7.976, Gleason 7(4+3). PSA is now 0.366.)

@jeffmarc Any direction down here in the Tampa Bay area of Florida?

@dailyeffort Bill, many, many thx for your guidance. I truly appreciate your feedback on Lin together with your other insights. How you describe the initial visit is what is currently planned with me. Lin is one of the 3 that I will meet with on the initial visit.

Did you have your PET scan done before you met with the team for your first visit? The urologist has put an order in but he came back and said it takes a while to secure a date. Current order is to have the scan done at Overlake Hospital. That said, I really want to get it done before initial meeting with Lin and others on Oct 8 so that I can have a more thorough and relevant discussion based on the scan, biopsy and other lab work. I am planning to call Overlake on Tue and also Fred Hutch to see which one can do the test before the first visit.

Lastly, Bill would you be open to a brief chat by phone or email to chat further about your experience at Hutch? If not no worries - I understand.

Ty

@brianjarvis Ty for sharing the NCCN guideline visual. I read about this in another thread (it may be you that shared the visual) and I went and downloaded the report.

My Gleason 9 is 4+5...

Did your MRI report or biopsy report mention anything about: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma? - There was nothing included regarding this in the biopsy...

To clarify, is ADT+ARPI different from alternative 1 I referenced in my post:
Advanced Radiation + Hormone Therapy (ADT)

Please advise if able on this so I can research ARPI further.

Ty

ADT (androgen deprivation therapy) can be one of: Lupron, Eligard, Prostap, Lucrin, Camcevi, Zoladex, Trelstar, Pamorelin, Decapeptyl, Firmagon, or Orgovyx.

Advanced radiation usually refers to IMRT (photon) or proton. But it could also refer to VMAT, IGRT, SBRT, MR-Linac, and others,…..

ARPI (androgen receptor pathway inhibitor) can be one of: Zytiga (abiraterone), Erleada (apalutimide), Xtandi (enzalutimide), or Nubeqa (darolutamide).